DOI： 10.1177/1179556519855387

PubMed

出版者・発行元：一般社団法人 日本歯科麻酔学会  

<p>  In patients with single ventricle heart disease, non-cardiac surgery using the Glenn procedure can be performed to alleviate cyanosis prior to repair using the Fontan procedure. We performed general anesthesia management during lip repair and palatoplasty in a patient with left ventricular hypoplasia following a Glenn procedure.</p><p>  The patient underwent lip repair at an age of 1 year and 2 months and a palatoplasty at the age of 1 year and 10 months. During the preoperative examinations, hemorrhagic diathesis, hypoxemia, and secondary polycythemia were observed.</p><p>  General anesthesia was induced using midazolam, fentanyl, and remifentanil and was maintained using fentanyl and sevoflurane in oxygen (F<span style="font-variant: small-caps;">io</span>₂=0.47). Low blood pressure was treated with the administration of an α1 receptor stimulant or volume expansion with infusion to prevent an increase in pulmonary vascular resistance and to maintain the pulmonary blood flow. In addition, pulmonary blood flow was maintained by increased oxygen administration and mild hyperventilation, inhibiting any deterioration in oxygenation through the maintenance of blood flow. After the palatoplasty, hypoxemia and intraoral bleeding were observed, and reintubation was performed.</p><p>  Patients who are scheduled to undergo a palatoplasty have a high risk of bleeding because the wound surface remains in front of the palate. In addition, the risk of bleeding increases in patients with cyanosis because of the use of antithrombotic drugs, the increase in collateral blood flow, and the presence of secondary polycythemia.</p><p>  In conclusion, the risks of increased pulmonary vascular resistance, hypoxemia, and increased bleeding must be considered for safe anesthesia during a palatoplasty in patients with cyanotic heart disease.</p>

DOI： 10.24569/jjdsa.47.2_65